Introduction
While varying in extent and frequency, restraining children can be part of pediatric nurses’ routine. Children receiving pediatric care are often subject to clinical procedures for which they are unwilling to comply. A frightened child is naturally reluctant to the care and will at times put up a struggle. Sometimes, nurses may perceive themselves forced to physically restraint the child to carry on with the procedure, which only increases the level of distress.
This finding raises the quandary of using restraint while providing care. The daily or even usual use of force to provide pediatric care is slowly but steadily gaining exposure in medical literature, mainly in the context of inducting anesthesia in children.1 In especially difficult circumstances, they can have significant consequences. For example, applying forcefully the mask on the child’s face during the induction of anesthesia will increase the risk for the child to be frightened of the procedure.2,3
Factors recognized as influencing the decision to restrain a child are the necessity to carry on the procedure, its nature, the child’s safety, his level of agitation, his age, the parents’ opinion, the team’s security, and the capacity to obtain the child’s consent. Yet the decision is still sometimes taken randomly, and some criteria determining the use of restraint have proven at times self-contradictory.4 This relatively common situation leaves the nurses with the dilemma of using force for the child’s “good.” One can hypothesize that there are also individual and team issues coming into play regarding the choice to restrain a child while providing care. The emerging controversy as to the use of forceful physical restraint as part of the care provision or a medical examination leaves scope for changing practices. (below the abstract and the link to whole article)
Abstract
Background:
The phenomenon of forceful physical restraint in pediatric care is an ethical issue because it confronts professionals with the dilemma of using force for the child’s best interest. This is a paradox. The perspective of healthcare professional working in pediatric wards needs further in-depth investigations.
Purpose:
To explore the perspectives and behaviors of healthcare professionals toward forceful physical restraint in pediatric care.
Methods:
This qualitative ethnographic study used focus groups with purposeful sampling. Thirty volunteer healthcare professionals (nurses, hospital aids, physiotherapists, and health educators) were recruited in five pediatric facilities in four hospitals around Paris, France, from March to June 2013. The data were processed using NVIVO software (QSR International Ltd. 1999–2013). The data analysis followed a qualitative methodological process.
Ethical Considerations:
The research was conducted in compliance with the Declaration of Helsinki. Written informed consent was collected systematically from participants.
Findings:
This study provides elements to help understand why restraint remains common despite its contradiction with the duty to protect the child and the child’s rights. All participants considered the use of forceful physical restraint to be a frequent difficulty in pediatrics. Greater interest in the child’s health was systematically used to justify the use of force, with little consideration for contradictory or ethical aspects. Raising the issue of forceful restraint always triggered discomfort, unease and an outpour of emotions among healthcare professionals. The findings have highlighted a form of hierarchy of duties that give priority to the execution of the technical procedure and legitimize the use of restraint. Professionals seemed to temporarily suspend their ability to empathize in order to apply restraint to carry out a technical procedure. This observation has allowed us to suggest the concept of “transient empathic blindness.”
Conclusion:
Using physical restraint during pediatric care was considered a common problem by participants. This practice must be questioned, and professionals must have access to training to find alternatives to strong restraint. Conceptualizing this phenomenon with the concept of “transient empathic blindness” could help professionals understand what happens in their minds when using forceful restraint.